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Vol. 16. Issue 6.
Pages 912-916 (November - December 2010)
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Vol. 16. Issue 6.
Pages 912-916 (November - December 2010)
SÉRIE DE CASOS
DOI: 10.1016/S0873-2159(15)31254-X
Open Access
High frequency chest wall oscillation plus Mechanical In-Exsufflation in Duchenne muscular dystrophy with respiratory complications related to pandemic Influenza A/H1N1
Oscilação de alta freqüência da parede torácica associado a in-exsuflação mecânica na distrofia muscular de Duchenne com complicações respiratórias relacionadas com o vírus pandémico da gripe A/H1N1
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G. Crescimannoa,b, O. Marronea
a Italian National Research Council, Institute of Biomedicine and Molecular Immunology, Palermo, Italy
b First Unit of Pneumology, ‘V. Cervello’ Hospital, Palermo, Italy
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Abstract

Two young boys with Duchenne muscular dystrophy, who had contracted 2009 pandemic influenza A/H1N1 (pH1N1), had been treated with antibiotics and steroids without significant improvement. One of them showed severe scoliosis. After hospitalization chest CT scan revealed extensive pulmonary bilateral segmental atelectasis. Their clinical and radiological findings rapidly improved when a sequential respiratory physiotherapy protocol was adopted that consisted of the application of multiple sessions of high-frequency chest wall oscillations, each one followed by mechanically assisted coughing manoeuvres. The protocol was well tolerated, effective, easy to apply and special positioning was not required. Fifteen days after treatment initiation both patients clinically recovered. This treatment can be very helpful for neuromuscular patients, particularly when scoliosis prevents conventional respiratory physiotherapy.

KEYWORDS:
Duchenne muscular dystrophy
High frequency chest wall oscillation
Pandemic H1N1 influenza
Atelectasis
Resumo

Duas crianças do sexo masculino com distrofia muscular de Duchenne que contraíram o vírus da gripe pandémica A/H1N1(pH1N1) de 2009 foram tratados com antibióticos e esteróides sem melhoria significativa.

Um deles revelou escoliose severa. Depois da hospitalização, um TAC ao peito revelou uma atelectasia pulmonar segmentar bilateral extensa. Os seus resultados clínicos e radiológicos melhoraram rapidamente quando foi adoptado um tratamento de fisioterapia respiratória sequencial, consistente na aplicação de múltiplas sessões de oscilações torácicas de alta frequência, cada uma seguida por exercícios de tosse mecanicamente assistidos. O tratamento foi bem tolerado, eficaz e fácil de aplicar, sendo que não foi necessário um posicionamento especial. Quinze dias depois do início do tratamento, ambos os pacientes se encontravam clinicamente recuperados. Este tratamento pode ser muito útil em pacientes com doenças neuromusculares, particularmente quando a escoliose impede a fisioterapia respiratória convencional.

Keywords:
PALAVRAS-CHAVE
Distrofia muscular de Duchenne
Oscilação torácica de alta frequência
Pandemia de gripe H1N1
Atelectasia
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Copyright © 2010. Sociedade Portuguesa de Pneumologia/SPP
Pulmonology

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